Provider Demographics
NPI:1114407707
Name:RODGERS, COURTNEY D'NAY (EARLY INTERVENTION)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:D'NAY
Last Name:RODGERS
Suffix:
Gender:F
Credentials:EARLY INTERVENTION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2821
Mailing Address - Country:US
Mailing Address - Phone:708-207-1467
Mailing Address - Fax:
Practice Address - Street 1:1333 BURR RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6423
Practice Address - Country:US
Practice Address - Phone:630-870-0631
Practice Address - Fax:855-811-0592
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217000407235Z00000X
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1063868586Medicaid